Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363L00000X | Nurse Practitioner | R189380 | MD |
Y | 363LF0000X | Nurse Practitioner - Family Medicine | R189380 | MD |
N | 363LP2300X | Nurse Practitioner - Primary Care | R189380 | MD |
NPI | 1043682685 |
---|---|
Provider Name | Ms. Christiana N Ikome |
First Address | Owings Mills, MD 21117-5826 |
Second Address | Owings Mills, MD 21117-5826 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/10/2015 |
Last Update Date | 28/10/2015 |